Efetividade dos princípios do sistema único de saúde na atenção primária à saúde: revisão sistemática / Effectiveness of the principles of the unified health system in primary health Care: systematic review of the literature

Este estudo teve como objetivo realizar uma revisão sistemática das publicações científicas que buscavam identificar a efetividade ou não dos princípios doutrinários e organizativos do Sistema Único de Saúde na Atenção Primária à Saúde e nos serviços por ela englobados no Brasil. Realizou-se uma revisão sistemática de literatura, com busca na Biblioteca Virtual em Saúde, baseada nos estudos publicados nos últimos dez anos (2006-2015), a partir dos descritores Atenção Primária à Saúde, Direito à Saúde, Efetividade e Sistema Único de Saúde, resultando em 29 publicações relacionadas ao tema. Estas foram analisadas por ano de publicação, tipos de estudo, princípio estudado, tipos de serviço, usuários e/ou categorias profissionais analisadas e regiões e Unidade Federadas analisadas. Obteve-se que os princípios doutrinários não foram plenamente efetivados pela presença de conduta profissional centralizada no modelo biomédico, houve descompasso entre as necessidades do usuário e o que era oferecido e falta de recursos humanos e de acesso aos serviços pelos usuários. Em relação aos princípios organizativos, foi exposto que a precária acessibilidade ao atendimento especializado, a falta de apoio do Estado no processo de municipalização, a baixa cobertura de serviços no espaço geográfico e um processo democrático deficitário prejudicaram sua efetividade. Os resultados dos estudos identificam a importância dos princípios e de sua efetividade para a qualificação dos serviços e satisfação dos usuários e profissionais neles inseridos, o que não foi plenamente encontrado nos serviços da Atenção Primária à Saúde.

This study aimed to carry out a systematic review of the scientific publications that sought to identify the effectiveness, or not, of the doctrinal and organizational principles of the Unified Health System in Primary Health Care and in the services it encompasses in Brazil. We conducted a systematic review of the literature, searching in the Virtual Health Library, based on studies published in the last ten years (2006-2015), using the descriptors Primary Health Care, Right to Health, Effectiveness, and Unified Health System, resulting in 29 publications related to the topic. They were analyzed by year of publication, type of study, principle studied, types of service, users and/or professional categories analyzed, and Regions and Federated Unit (State) analyzed. It was found that the doctrinal principles were not fully realized by the presence of professional conduct centralized in the biomedical model. There was a mismatch between the needs of the user and what was offered, and a lack of human resources and access to services by the users. Regarding the organizational principles, it was shown that the precarious accessibility to specialized services, the lack of government support in the municipalization process, the low coverage of services in the geographic space, and an unsatisfactory democratic process jeopardized its effectiveness. The results of the studies identified the importance of the principles and their effectiveness for the qualification of the services and satisfaction of users and professionals included in it, which was not fully found in Primary Health Care services.

Prevalence of dental fractures and associated factors in students of Valinhos, SP, Brazil

AIM: To investigate the prevalence of dental fractures and their association with risk factors in the permanent dentition of adolescents in Valinhos, SP, Brazil. METHODS: The study population was obtained using the probability sampling method and comprised 379 students between 13 and 19 years old enrolled in the eight State schools of the city, who were examined by nine pairs of calibrated dentists (Kappa>0.80). The presence of dental fractures in permanent anterior incisors, as well as the presence of considerable overjet (> 5mm) and lip seal was evaluated in a clinical-epidemiological examination. RESULTS: The prevalence of dental trauma was 27.1%. The most frequent lesions were enamel fractures (72.6%) of which falls were the main cause (45.7%). No association was found between the presence of considerable overjet and deficient lip seal (chi-square test; p>0.05). CONCLUSIONS: The prevalence of dental trauma in the studied population was expressive when compared with the literature, but the analyzed oral aspects did not contribute to its occurrence.